This competing continuation proposes to extend the follow-up of a randomized trial that is currently in progress from 12 months to 2 years. The NIMH-funded trial, "Family Preservation versus Hospitalization of SED Youths (MH51852)," is examining the clinical and cost effectiveness of multisystemic therapy as a family-based alternative to the psychiatric hospitalization of children and adolescents presenting mental health emergencies. Similarly, the proposed 2-year follow-up would track longer term clinical and cost-related (i.e., out-of-home placements) outcomes. The current study and the proposed competing continuation address several important issues in the field of mental health services for children, including the disproportionate allocation of fiscal resources to institution-based settings, the clinical outcomes associated with psychiatric hospitalization and alternatives to hospitalization, and the longer-term clinical and cost effectiveness of innovative treatment models. Importantly, the present project is yielding valuable information pertaining to the original aims and hypotheses. Specifically, in comparison with hospitalization, MST significantly reduced youth externalizing symptoms, improved family relations, increased school attendance, and produced high consumer satisfaction and post-treatment. Likewise, preliminary analyses of 6-month and 12-month follow-up data generally support the capacity of MST to maintain these treatment gains. Moreover, placement outcomes support the short-term capacity of MST to reduce rates and duration of hospitalization and other out-of-homes placements substantially. Preliminary examination of hospitalization and placement rates during the 12-month follow-up suggest that the short-term reduction in hospitalization and out-of-home placements for youths in the MST condition were not offset by a subsequent increase in hospitalization and other placements. The aims of the 2-year follow up, which would be conducted 1 year after the 12-month follow-up, address the major outcome domains of mental health services for children and adolescents, youth symptoms, youth functioning, environmental contexts, and systems. Specifically: Aim 1. To assess the outcomes for the MST and hospitalization conditions with regard to youth symptoms, youth functioning, and environment context at a 2-year follow-up. Aim 2. To determine rates and durations of out-of-home placements (foster placement, group home placement, residential treatment, hospitalization) as well as associated costs for youths in the MST and hospitalization conditions at a 2-year follow-up. Aim 3. To examine variables that might moderate or mediate MST-related and hospitalization-related clinical and services/cost outcomes at the 2-year follow-up.